Editor-in-Chief Dr Graham Jackson, a UK-based Consultant Cardiologist, has called for greater public awareness of the dangers and consequences of the counterfeit drugs market, which is expected to be worth Pounds 55 billion by 2010.

"Harmful ingredients found in counterfeit medicines include arsenic, boric acid, leaded road paint, floor and shoe polish, talcum powder, chalk and brick dust and nickel" he points out.

"In one scheme, Americans buying fake Viagra on the internet were actually helping to fund Middle East terrorism, unknowingly jeopardising the lives of men and women serving in their own armed forces."

The UK's Medicines and Healthcare products Regulatory Agency estimates that nearly 62 per cent of the prescription only medicines offered on the internet, without the need for a prescription, are fakes.

"Alarmingly these include fake drugs that could have devastating consequences, like counterfeit medication for potentially fatal conditions like cancer and high blood pressure. Others can include no active ingredients or harmful ingredients like amphetamines."

Although some internet pharmacies are legitimate, a significant number are illegal and often operate internationally, selling products of unknown content or origin.

"Counterfeit drugs may originate from many different countries, where governments have little or no controls in place, and be then imported into other countries without being inspected" says Dr Jackson.

"In 2004 Pfizer investigated one Canadian online pharmacy and discovered that the domain name was hosted in Korea and registered in St Kitts. Orders placed on the web were dispatched in a plain envelope from Oklahoma City with a non-existent return address."

The challenge of combating these criminal and potentially life-threatening activities is a major concern, he says. However efforts are being hampered by a lack of resources, manpower, adequate legislation and coordination between countries.

Dr Jackson stresses that raising public awareness is essential, as lives are clearly at risk.

"Patient groups need to be motivated to educate men and women about the dangers of buying medication outside the healthcare system" he says. "Prescription only medicines are just that, so being able to buy them without a script is a sure sign of illegal practice.

"The best way to avoid counterfeit drugs is to use a reputable and regulated pharmacy that dispenses with a legal prescription."

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